Transthoracic echocardiography for non-invasive assessment of coronary vasodilator function after DES implantation

Varho, Ville; Karjalainen, Pasi P.; Ylitalo, Antti; Airaksinen, Juhani; Mikkelsson, Jussi; Sia, Jussi; Pietilä, Mikko; Kiviniemi, Tuomas

doi:10.1093/ehjci/jeu059

Cited by 5 publications

(2 citation statements)

References 24 publications

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“…The results showed that there was no statistically significant difference in the comparison of MACE in 30 days after surgery between the two groups, such as the ratio of deaths, non-lethal myocardial infarction cases and non-lethal cerebrovascular cases. The 1-year and 2-year survival rates in both groups were higher than 90 and 80%, respectively, which was in accordance with the results of studies conducted by Fröhlich et al and Varho et al ( 13 , 14 ). Such results indicate that determining the implementation of coronary artery stenting by the FFR value can achieve better efficacy in guiding clinical practice, which can effectively reduce the ratio of less considered stenting procedures, facilitate the functional revascularization, and minimize the surgical risk and the adverse reaction due to the application of a contrast agent ( 15 ).…”

Section: Discussionsupporting

confidence: 92%

Analysis of the clinical value of fractional flow reserve for prognosis evaluation of patients of percutaneous coronary intervention

Zhao

Zheng

et al. 2017

Exp Ther Med

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We investigated the clinical value of fractional flow reserve (FFR) for the prognostic evaluation of patients with percutaneous coronary intervention. We enrolled 120 patients who were admitted to the hospital to undergo percutaneous coronary intervention for acute coronary syndromes between May 2014 and June 2015. The 120 patients were divided into two groups, the observation group and the control group, according to the post-surgery level of FFR. Each cohort contained 60 patients. These patients were divided into the occurrence group (n=45) and the non-occurrence group (n=75), classified according to the occurrence of major adverse cardiovascular events (MACE). There were no statistically significant differences in the comparison of the occurrence rate of MACE within 30 days after surgery, such as lethal or non-lethal myocardial infarction or non-lethal cerebrovascular events, between the observational group and the control group (P>0.05). For the observation group, the 1-year survival cases were 56 with a survival rate of 93.3%, and 2-year survival cases were 50 with a survival rate of 83.3%. In the control group, the 1-year and 2-year survival cases were respectively 55 and 49 (survival rate of 91.7 and 81.7%). The occurrence rates of hyperlipidemia and ratio of patients with a history of smoking and drinking in the occurrence group were significantly higher than those in the non-occurrence group (P<0.05). The mean arterial pressure in the occurrence group was significantly higher than that in the non-occurrence group (P<0.05). Heart rate in the occurrence group is significantly faster than that in the non-occurrence group (P<0.05) and the stenosis degree in the occurrence group was significantly higher than that in the non-occurrence group (P<0.05). The left ventricular ejection fraction (LVEF) before surgery in the occurrence group was significantly lower than that in the non-occurrence group (P<0.05). There were no remarkable differences in comparison of the pre-treatment FFR between the occurrence group and the non-occurrence group (P>0.05), but the post-treatment FFR in the occurrence group was significantly lower than that in the non-occurrence group (P<0.05). Increased blood fat, a history of smoking and drinking, augmented mean arterial pressure, accelerated heart rate, severe coronary artery stenosis and the remarkably decreased LVEF were all identified as independent risk factors leading to major adverse myocardial events. The sum of specificity and sensitivity of treatment reached the peak when the post-surgery FFR was 0.875, the calculated sensitivity was 82.4%, and the specificity was 50.8%. In conclusion, measurement of FFR after percutaneous coronary intervention could not only effectively evaluate the target vessel revascularization, but also predict the occurrence of major adverse myocardial events 1 year after surgery, which could serve as the guidance for clinical treatment.

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Section: Discussionsupporting

confidence: 92%

Analysis of the clinical value of fractional flow reserve for prognosis evaluation of patients of percutaneous coronary intervention

Zhao

Zheng

et al. 2017

Exp Ther Med

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“…when planning studies with purpose of testing the effect of interventions on CFR. That CFR and microvascular function is a dynamic parameter is also illustrated by previous findings of improvement in CFR early (days) after stenting both in patients with and without MI, with further improvement in some but not all patients after 3–6 months [ 50 – 52 ], which can relate to myocardial recovery [ 52 ], and in-stent restenosis [ 9 , 51 ]. Likewise, improvement in CFR has been illustrated from 1 to 6 months after CABG [ 53 ].…”

Section: Discussionmentioning

confidence: 58%

Coronary flow velocity reserve by echocardiography: feasibility, reproducibility and agreement with PET in overweight and obese patients with stable and revascularized coronary artery disease

Olsen

Pedersen

Snoer

et al. 2015

Cardiovasc Ultrasound

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BackgroundCoronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography of the LAD is used to assess microvascular function but validation studies in clinical settings are lacking. We aimed to assess feasibility, reproducibility and agreement with myocardial flow reserve (MFR) measured by PET in overweight and obese patients.MethodsParticipants with revascularized coronary artery disease were examined by CFVR. Subgroups were examined by repeated CFVR (reproducibility) or Rubidium-82-PET (agreement). To account for time variation, results were computed for scans performed within a week (1-week) and for all scans regardless of time gap (total) and to account for scar tissue for patients with and without previous myocardial infarction (MI).ResultsEighty-six patients with median BMI 30.9 (IQR 29.4–32.9) kg × m−2 and CFVR 2.29 (1.90–2.63) were included. CFVR was feasible in 83 (97 %) using a contrast agent in 14 %. For reproducibility overall (n = 21) limits of agreement (LOA) were (−0.75;0.71), within-subjects coefficient of variation (CV) 11 %, and reliability 0.84. For reproducibility within 1-week (n = 13) LOA were (−0.33;0.25), within-subjects CV 5 %, and reliability 0.97. Agreement with MFR of the LAD territory (n = 35) was without significant bias and overall LOA were (−1.40;1.46). Agreement was best for examinations performed within 1-week of participants without MI of the LAD-territory (n = 12); LOA = (−0.68;0.88).ConclusionsCFVR was highly feasible with a good reproducibility on par with other contemporary measures applied in cardiology. Agreement with MFR was acceptable, though discrepancy related to prior MI has to be considered. CFVR of LAD is a valid tool in overweight and obese patients.

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Practical Aspects of Intracoronary Pressure and Flow Measurements

Seto

Kern

2017

Physiological Assessment of Coronary Stenoses and the Microcirculation

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Transthoracic echocardiography for non-invasive assessment of coronary vasodilator function after DES implantation

Abstract: TTE is a feasible and reliable method for the assessment of CFR and vasodilator dysfunction after DES implantation. Values obtained with this method successfully find abnormal CFR confirmed with the invasive thermodilution method.

Cited by 5 publications

References 24 publications

Analysis of the clinical value of fractional flow reserve for prognosis evaluation of patients of percutaneous coronary intervention

Analysis of the clinical value of fractional flow reserve for prognosis evaluation of patients of percutaneous coronary intervention

Coronary flow velocity reserve by echocardiography: feasibility, reproducibility and agreement with PET in overweight and obese patients with stable and revascularized coronary artery disease

Practical Aspects of Intracoronary Pressure and Flow Measurements

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